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What will happen if Democrats try the "go it alone" strategy to pass national health care?

That's not even a question in the House, where Speaker Nancy Pelosi has cut Republicans out of health care from the very beginning. House Democrats have been going it alone all along, and if they can agree among themselves on a health care bill, it will pass.

But the Senate is another story. Republicans see the Senate as their great hope, and there's no doubt the GOP could do some serious damage to any Democratic bill. But Republicans have to face the fact that Democrats have the power, on their own, to pass a bill that could ultimately lead to the liberal dream of national health care.

First, the best-case scenario for the GOP. Republican staffers are studying the Senate's arcane rules governing the process known as "reconciliation." Those rules allow the Senate to pass some measures with a simple majority of 51 votes, rather than a filibuster-proof 60 votes. Theoretically at least, Democrats could pass a health care bill with no Republican help even if all 60 Democrats are not on board.

But reconciliation is allowed only on proposals that deal directly with the budget or are primarily fiscal in nature. So Democrats could use reconciliation to pass parts of the health care bill that have a direct fiscal effect, but not other measures creating things like health care supervision agencies. If Democrats try to pass measures that are deemed "extraneous," Republicans could object and have the measures stripped from the bill.

That is, for example, what undoubtedly would have happened to the notorious end-of-life provisions that have now been removed from the Senate Finance Committee's bill. In that same way, it's possible Republicans could kill a lot of what is currently in the health care reform proposals. (In addition, any measure passed by reconciliation would be temporary, usually lasting five years.)

The prospect of a paragraph-by-paragraph reconciliation fight has led to what some Republicans call the "Swiss cheese scenario." Each time Republicans defeat a portion of the bill, they'll poke another hole in the Democrats' ambitions. Poke enough holes, and the Democrats' vaunted health care plan is Swiss cheese.

There's no doubt that prospect scares some influential Democrats. Sen. Robert Byrd himself is opposed to using reconciliation for health care, calling it "an outrage that must be resisted." Sen. Max Baucus calls it "not a good idea," and Sen. Jay Rockefeller says it could create "a bill that goes nowhere." They're warning their colleagues not to take the go-it-alone route.

But there's another way of looking at it. Sure, Democrats can't get everything they want if they have to go through reconciliation. But look at health care reform as an unfinished building. There are plenty of examples of past legislation that began somewhat modestly and expanded as the years went on. The State Children's Health Insurance Program, or S-CHIP, has been enormously expanded. Medicare and Medicare are far bigger today than when they were created. Programs grow over time as lawmakers add features and increase eligibility.

The story could be the same for the current health care proposals, through which Democrats, with no Republican support, could put in place the basic structure of a national health care plan. It doesn't have to be gold-plated, or even finished. That could come later.

"You can build a building that's missing certain features," says one old Senate hand. "Maybe the plumbing's not there, or the wiring. But the bottom line is, you have laid the foundation, and built the structure, and it becomes easier later on to add the plumbing, and add the wiring. You have set up a structure so that all you have to do in the future is make incremental changes."

Veterans of the Senate tend to flinch from the sort of all-out warfare reconciliation could bring. But the fact is, reconciliation might in the end be the Democrats' best option. And it might work. Democrats wouldn't get everything they wanted, but they could create the structure for future growth. Later on, they'll add the plumbing. And the wiring. And maybe a chandelier.

It's precisely that scenario that most terrifies Republicans. Forget about Swiss cheese. Democrats are intent on building something much more substantial, and Republicans don't have the votes to stop them.

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